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    The death of Alexander the Great

    THE DEATH OF ALEXANDER THE GREAT

    ABSTRACTThe circumstances of Alexanders death are reviewed. Since contemporary sources varyin their accounts of the reason for his death, they are briefly reviewed and assessed.The account of Alexanders final illness is then discussed as recorded in the KingsJournaland theLiber de morte testamentumque Alexandri Magni. The theory that he waspoisoned is rejected, as is the hypothesis that he drank himself to death. His finalillness shows symptoms characteristic of malignant tertian malaria (Plasmodium fal-ciparum), possibly precipitated by recent wounds, exhaustion and heavy drinking.

    1. INTRODUCTIONAlexander, King of Macedonia, conqueror of the Persian empire, diedin Babylon at sunset on the 10th of June, 323 BC.1 He was not yet 33years old, had been king for 12 years and 8 months and had shownhimself to be fully deserving of the title The Great. Educated byAristotle, trained in warfare by his father Philip II, he invaded Asia atthe age of 22 and defeated Darius III within 3 years. He never returnedto Macedonia but commenced with the establishment of an Asian em-

    pire based on Hellenistic culture whilst incorporating the best elementsof the Persians and other conquered nations. With few exceptions hewas remarkably magnanimous towards his former enemies, perform-ing acts of justice far in advance of his time. As Tarn (1948:I.124-125) puts it:

    This was probably the most important thing about him: he was a greatdreamer. To be mystical and intensely practical, to dream greatly andto do greatly, is not given to many men; it is this combination whichgives Alexander his place apart in history.

    1 On the controversy about the exact date of Alexanders death, cf. Hamilton

    (1969:210).

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    Figure 2: Silver coin from Thrace with the head of Alexander,portrayed wearing the horns of Zeus Amon,a god with both Eastern and Western ties.

    Alexanders sudden death left his large and heterogeneous empirewithout a predetermined successor. This caused a protracted powerstruggle among his generals. Furthermore, the circumstances of his deathsoon became controversial rumours of foul play and poisoning arosealmost immediately, and were exploited by his contemporaries to furthertheir own ends. The aim of this article is to review this historical event.

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    2. RELEVANT LITERARY SOURCESOur interpretation of the information about the last days and the death

    of Alexander will depend on the value we attach to the various ancientsources. Modern historians still vary in their assessment of these sources,which results in different views of the reasons for the death of Alex-ander. A brief overview of the ancient sources will be given.

    2.1 Contemporary sources

    Callisthenes was Aristotles nephew, and an experienced writer ap-pointed by Alexander to prepare a history of the Asian campaign. Whenhe was executed in 327 BC for complicity in a plot, his history co-

    vered the period up to 331 BC, and possibly even 329 BC. It is pro-bable that his death lead to growing animosity between Alexander andhis former tutor, Aristotle, as well as between the king and the Peri-patetic School in Athens.

    Ptolemy was one of Alexanders generals and later became Kingof Egypt in 304 BC. He published his History in the years 285-283BC, making extensive use of the Kings Journals, also known as the

    Royal Ephemerides. Although scholars have questioned the authenticity

    of this document,2

    it is accepted that Macedonian kings at least fromthe time of Philip II kept daily records of state.3 Responsible secre-taries, of whom Eumenes was best known, travelled with Alexander,and if everything went according to plan, the records would after hisdeath have accompanied his body back to Pella (the capitol of Mace-donia) or Aegae for burial in the cemetery of the Macedonian kings.4

    We know, however, that after Alexanders body had been prepared byEgyptian and Mesopotamian embalmers, it was diverted to Egypt byPtolemy on its way back to Macedonia, late in 322 or early 321 BC.

    2 Cf. Samuel (1965:1-12) and Bosworth (1971:112-136).

    3 Cf. Pearson (1954:434):

    ... there is certainly no reason to doubt that some kind of diary was kept,recording the events of each day, the kings conferences, the orders he issued,the reports he received, and so on.

    Cf. too Tarn (1948:II.1 et passim) and Hammond (1983:5-6).

    4 Hammond (1980:248).

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    With it presumably went theKings Journals.5 Ptolemy was the onlygeneral (and one of very few historians) to have seen these documentsafter 322 BC.

    Cleitarchus of Alexandria was an influential contemporary writer,but he did not accompany Alexander. He collected second-hand in-formation which he published as dramatic and sensational (often fan-tastic) stories at times very negatively disposed towards Alexander.These appeared as a total history of more than 12 books between 322and 314 BC. He was widely read and quoted but held in low esteemby serious scholars. Cicero, for instance, remarked that he was a betterorator than historian, and quite ready to lie if it made the story more

    lively (Brutus 11.42), and Quintilian called him brilliantly ingeniousbut notoriously untrustworthy (Institutiones X.1.74).

    Aristobolus was a Greek engineer in Alexanders service. He de-serves special mention because of his meticulous history, publishedbetween 305 and 290 BC. However, its emphasis was on scientific andgeographical rather than on military matters.

    Hieronymus was a follower of Eumenes and a dependable historianwho had much influence on Diodorus.

    TheAlexander Romance is a body of literature which came into beingover a considerable period. It is a highly romanticised work contain-ing fables and obvious fiction about Alexanders life and exploits.6

    However, it also contains much factual data. Cleitarchuss stories formpart of this literature.

    TheLiber de morte testamentumque Alexandri Magni is a potentiallyvery significant document which circulated after Alexanders death.It was written by one Holkias, possibly in 317 BC, and was includedat a later stage in various versions of theAlexander Romance.7 This pam-phlet which purports to record the true history of Alexanders deathand his final testament, suggests that he was poisoned, and in the plot

    5 Pausanias 1.6.3.

    6 Cf. Hammond (1980:4).

    7 Cf. Heckel (1988) for the full text (as it occurs in the so-called Metz Epitome

    and in Recension A of Pseudo-Callisthenes) and for a discussion of the date, pur-

    pose and authorship of this document.

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    various influential personalities involved in the struggle for succes-sion were implicated. It is dealt with in more detail below.

    2.2 Sources from the Roman eraNone of the contemporary sources discussed above have survived; theyare known to us only by way of references in later authors. These his-torians, who lived some 400 years later during the late Roman Republicand early Empire, are the only extant sources for the life and timesof Alexander.

    Diodorus Siculus (1st century BC) was a Greek historian who wrotea universal history, the Bibliothk, from mythological times to 60 BC.

    His main source is Cleitarchus, but he also quoted from Aristobulus,Hieronymus and from sources said to have originated from Greekmercenaries fighting for Darius III.

    Quintus Curtius Rufus (1st/2nd century AD) was a Roman rheto-rician and historian who wrote a ten-book history of Alexander, theHistoriae Alexandri. He relied very heavily on Cleitarchus; apart fromthis the exigencies of rhetoric determined the selection of his sourcematerial.

    Plutarch (46-120 AD), the Greek biographer and moral philosopher,is known mainly for his Fifty parallel lives, written to exemplify virtue(or vice) in the careers of great men in Greek and Roman history. In thiswork Alexander is compared with Julius Caesar. Plutarch reportedobjectively from every source available, from the best to the worst(Tarn 1948:II.296).

    Arrian (Lucius Flavius Arrianus, 95-180 AD) was a Greek historian,and one of the most distinguished writers of his day. His most famouswork deals with the age of Alexander; the only extant part is theAna-basis of Alexander, a history of Alexander in seven books from hisaccession to his death, based on theKings Journals and Ptolemys ren-dering of it, supplemented mainly by Aristobulus.

    Justin (Marcus Junianus Justinus, 2nd, 3rd or 4th century AD) wasthe author of a Latin epitome of the otherwise lostPhilippic Historiesof Pompeius Trogus, a less significant and less accurate contribution.

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    2.3 An assessment of the sources

    In his book, Three historians of Alexander the Great. The so-called Vulgateauthors, Diodorus, Justin and Curtius (1983), Hammond set himself thetask of assessing the value of each of the five main accounts of the lifeof Alexander which has survived (Arrian, Diodorus, Justin, Curtius andPlutarch). It very soon emerges, merely by looking at these authorsaccounts of Alexanders last days, that two groups can be distinguished(Hammond 1983:4-5). On the one hand there are Arrian and Plu-tarch: Arrian in his rendering of the final illness of Alexander, abbre-viates and paraphrases the relevant passage in theKings Journals, andat the end remarks that the accounts of Ptolemy and Aristobulus were

    not far from this [account] (Anabasis 7.26.3); Plutarchs account(Alexander76-77.1) is so similar to Arrians that there is little doubtthat each was drawing independently on the same passage in theKings

    Journals. On the other hand there are Diodorus, Justin and Curtius,whose accounts are totally incompatible with the first group. Whichgroup is then to be regarded as correct? It largely depends on onesassessment of the authenticity of theKings Journals. Scholars like Samuel(1965), Hamilton (1969) and Bosworth (1971) maintain that theKings

    Journals was a forgery made in antiquity, and they therefore favour

    the latter group of authors. Hammond (1983:4-11), however, makesout a very convincing case for the authenticity of theKings Journals,8

    and thus believes that Arrian and Plutarch are to be regarded as de-pendable.

    Two contemporary sources in particular were hostile to Alexanderand recorded a very negative image in many respects. The sensation-al stories of Cleitarchus still had a wide appeal, although he was notheld in high regard by serious historians. And after the execution of

    8 Cf. Hammonds scathing remark in this regard (1983:6):

    It is, of course, an exciting idea that a modern scholar, operating only withparaphrased fragments, may be able to prove an ancient work to have beena forgery so ingeniously constructed that it deceived four ancient scholars(Plutarch, Arrian, Aelian VH 3.23, and Athenaeus 10.434b). But excite-ment is not enough; we need very strong arguments to support the idea.

    He then convincingly refutes the arguments against the genuineness of theKings

    Journals.

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    Callisthenes, Aristotles nephew, the Peripatetic School in Athens pro-ceeded to slander Alexander by inter alia picturing him as a debaucherand tyrant, and to attribute his achievements to luck and to the efforts

    of others. This view was still very popular in the Roman era, untilPlutarch and Arrian, in particular, proposed a contrary view.

    The account of Alexanders final illness as recorded by the two majorsources, theKings Journals (preserved in inter alia Plutarch and Arrian)and theLiber de morte Alexandri Magni (in which the views of Clei-tarchus and others are represented), will now be discussed. In an at-tempt to find the most likely reason for his death, information pro-vided by these two sources will be evaluated carefully in the light of

    modern medical knowledge and circumstantial evidence such as theplace where he died, the season and prevalent diseases at that time. Itmust be emphasised that absolute certainty cannot be reached in viewof the inadequate medical descriptions given by historians more than2 000 years ago.

    3. LAST DAYS OF ALEXANDER

    3.1 Previous medical history according to the sources

    Alexander was of less than average stature, well built, very fair witha tendency towards a ruddy complexion (Plutarch,Alexander4.3). Inbattle he led by example and right through his career was extremelypopular with his troops with whom he shared all hardships (Plutarch,

    Alexander42.7-10 and Arrian,Anabasis 6.26.1-3). He was woundedoften and seriously (Plutarch,Alexander58.1). At Granicus (334 BC)his life was saved by Cleitus after serious injury (Plutarch,Alexander16.11 and Arrian,Anabasis 16).

    In his Parthian campaign (331 BC) he was hit in the lower leg byan arrow which so shattered the bone that bone-fragments had to beremoved (Plutarch,Alexander45.5 and Curtius Rufus, Historiae Alex-

    andri 7.6.3). Plutarch also tells of an occasion when he suffered dimmedvision after a severe blow to the nape of the neck (Alexander45.5 andCurtius, Historiae Alexandri 7.6.22). During the assault on Malli (India,325 BC) an arrow pierced his breastplate and chest wall above thenipple, probably damaging the lung. The arrow was cut out with a

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    sword, he bled profusely and fainted (Plutarch,Alexander43.6-12 andArrian,Anabasis 6.10-11). Tarn (1948:I.103) maintains that he neverfully recovered from this incident and that his weakened state contri-buted to his ultimate death.

    Figure 3: Alexander the great. Capitoline Museum, Rome.

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    Besides an attack of severe diarrhoea we know of only one otherserious illness prior to the final incident. During his assault on Tarsus(333 BC) he fell dangerously ill with symptoms very similar to his

    final illness. According to Arrian he was eventually cured by a boyhoodphysician-friend, after he had lost his speech and become comatosed(Anabasis 2.4 and Plutarch,Alexander19.4-10).

    Cleitarchus and the Peripatetic School of Aristotle were mainlyresponsible for creating a negative image of Alexander as an alcoholic.9

    It is probable that Alexander did drink heavily from time to time (likehis fellow officers), and it is true that he murdered Cleitus (who savedhis life at Granicus) in a drunken brawl (Plutarch,Alexander50.1-

    51.11). But Alexander was no drunkard, and Plutarchs remark in thisregard that the king let nothing hinder him when there was work tobe done (Alexander23.1-2), should be taken seriously.10

    9 Hammond (1983:78). Ephippus of Olynthus too wrote a hostile pamphlet, On

    the end of Alexander and Hephaestion, in which he attributed Alexanders death

    to excessive drinking (Fragmente der griechischen Historiker126 F 3); this view is also

    found in Nicobulus (Fragmente der griechischen Historiker127 F 1 and F 2) and passed

    as truth into theAlexander Romance. This theory still has followers in modern times:

    Lane Fox (1975:467) refers to Alexanders last months as a continuous record

    of carousing and Alexanders final month of debauchery. Bosworth (1971:122)

    refers to this period as

    a drinking marathon unique in history, in which the king spent his life al-ternately drinking himself to insensibility and sleeping off the results.

    This view, which is based on certain passages in theKings Journals, was examined

    in detail by Hammond, who came to the conclusion that these passages refer tothree dinner parties which Alexander attended within a period of a month at which

    he drank with his friends hardly an excessive programme for royalty (1980:

    298-9), and definitely not a justification for the views of Lane Fox and Bosworth.

    10 Cf. too Plutarch (Moralia 337f and 623e) where he gives the view of Alexanders

    contemporary, Aristobulus, which has the same drift. Cf. further Arrian (Anabasis

    7.29.4):

    As for his reputed heavy drinking, Aristobulus declares that his drinking boutswere prolonged not for their own sake for he was never, in fact, a heavydrinker but simply because he enjoyed the companionship of his friends.

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    3.2 The final illness

    According to theKings Journals Alexander returned to Babylon in May323 BC after journeying through the marshy Tigris-Euphrates delta.Within weeks he developed his final illness which lasted approxima-tely 10 days. In summary, Arrians description (Anabasis 7.25-27) is asfollows:

    After banqueting with friends far into the night during a time ofgeneral festivity for the whole army, he was invited to join in acarousal in honour of a god (probably Heracles) at the home of hisclose friend, Medius. After leaving the party, he bathed, slept mostof the next day and then rejoined the festivities at Medius home farinto the next night. He then bathed, ate a snack and slept on the spot,because he had a fever. On waking up he was carried by stretcherto a sacrificial ceremony (a daily event in his life) after which heremained lying in the mens room till nightfall. During this timehe was actively involved in issuing orders to commanding officersin preparation for a military operation (to Arabia) in five days time.He was then carried by stretcher to the Euphrates river to sail andbath before resting. The next three days he became more feverish, butstill made the customary daily sacrifices, bathed and discussed mil-itary operations. Very ill, he was then carried past his grief-stricken sol-diers into the palace. Unable to speak he nevertheless still receivedhis commanding officers. The fever continued unabated and two dayslater the army, fearing for his death, insisted on seeing him. As the

    soldiers filed past his bed, he was unable to speak to them but evenso welcomed each of them, raising his head with difficulty and greet-ing them with his eyes. Some of his generals, keeping an all-nightvigil in the shrine of Serapis, asked the god whether Alexander shouldbe brought there. The god indicated that it was better for him tostay where he was. Shortly afterwards Alexander died.

    TheLiber de morte document also contains the details of the fatefuldinner party at the house of Alexanders friend, Medius. It may be sum-marised as follows:

    When Alexander invaded Asia he left the able but elderly Antipaterin Macedonia to manage the European component of his domain andto look after the interests of his mother, the strong-willed and vin-dictive Olympias. She was displeased with Antipaters handling ofaffairs and continued to complain to her son. Eventually (324 BC)Alexander heeded her complaints and sent one of his best commanders,Craterus, with 10 000 Macedonian veterans to replace Antipater.Expecting to be killed in the process, an alarmed Antipater plottedwith Aristotle to assassinate Alexander, and sent his son, Cassander,to Babylon, ostensibly to argue his fathers case, but in fact to mur-der Alexander. For this purpose an exceedingly powerful poison was

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    prepared from the icy springwater near Nonakris in Arcadia apoison so virulent that it destroyed metal, and had to be transportedin a mules hoof. In Babylon Cassanders brother Iolaos, cupbearer ofAlexander, then poisoned his master at the banquet of Medius where

    most of the guests were party to the plot. On taking the poison Alex-ander felt a sharp pain in his back, cried out loudly and left the din-ner. Excruciating pain now set in and Alexander died slowly in thecourse of five days, during which time Iolaos succeeded in adminis-tering further doses of the poison. In his agony Alexander attempted todrown himself in the Euphrates but was saved by his Bactrian wife,Roxana. Cassander then fled to Cilicia to await the arrival of Iolaos,and in the presence of loyal followers, Alexander composed his lastwill. He divided his empire among his generals and appointed Per-diccas as his successor and future husband for Roxana. As in the versionof theKings Journals his mourning troops then filed past him beforehe died.

    The salient point of this document is the accusation of murderlevelled against the family of Antipater and identified collaborators atMediuss banquet. Heckel (1988) makes a convincing case that it wasa cleverly prepared forgery designed to benefit certain persons in thecomplicated struggle for Alexanders succession, whilst attempting toeliminate others and that it probably originated in 317 B.C. Clei-tarchus (cf. Diodorus Siculus 17.118.1 and Curtius, Historiae Alexandri10.10.14-19), Plutarch (Alexander77.5) and Arrian (Anabasis 7.27)all knew of the poisoning theory but rejected it. Furthermore, Engels(1978:224-5) points out that it is most unlikely that Alexander, whowas very swift in acting against conspiracies against his life real oralleged would allow himself to be slowly poisoned over five or moredays, while placidly drawing up his testament. None of the allegedaccomplices, or any one else for that matter, suffered any harm duringthe kings terminal illness. Recently Bosworth (1971:115-6 and 134-6) also rejected the Liber de morte document, but hypothesised that

    Alexander might well have been assassinated by disgruntled followers,alarmed by his progressive megalomania and autocratic tendencies.He presents evidence of a junta being formed which then brought offa successful coup dtataimed at establishing a balance of power amongthe plotting coalition members. This planned equilibrium subsistedfor a year but was abruptly shattered by Perdiccass bid for supremacy.

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    3.3 A medical perspective

    The theory that Alexander was poisoned has thus not yet been finallylaid to rest, as is also evident from Milnss suggestion (1968:256-6)that strychnine was administered at Mediuss banquet in unmixed wine a procedure apparently recommended by Theophrastus.11 However,Engels (1978:224) points out that it is the non-lethal variety of strych-nine which Theophrastus is referring to the lethal variety was ex-tremely bitter and would have been detected immediately. Further-more the symptoms of strychnine poisoning are very obvious12 and arenot substantiated by the symptoms recorded before Alexanders death(a violent intermittent fever, loss of voice and severe back pain). Neither

    do the symptoms of small doses of poison given over a period of timeaccord with those of Alexander.13

    Similarly the hypothesis that Alexander actually drank himself todeath, cannot be substantiated. The view that he was an alcoholic hasalready been refuted (cf. p.22 and notes 9 and 10), but Plutarchs reportregarding his final illness merits further comment:

    Aristobulus says that he had a raging fever, and that when he gotthirsty, he drank wine, whereupon he became delirious, and died onthe 30th day of the month Daesius (Moralia 337).

    In Curtius (Historiae Alexandri 10.10.10-11) we read that in the hotplain of Babylon the water was not as pure as in the mountain springsof Macedonia; it is understandable that what Alexander drank dailywas wine, not water. And when he became feverish, one can imagine thathe quenched his thirst with wine. It is thus possible that Alexandersconstitution was weakened by sporadic heavy drinking, and that itcontributed towards his final illness.

    The fact that Alexanders symptoms resemble those of malaria, was

    noted as early as 1872 by the French physician Emile Littr14 and has

    11 Historia Plantarum 9.11.5-6, reference in Engels (1978:224 n.4).

    12 muscular convulsions within fifteen to thirty minutes of ingestion, followed

    in a short time by unconsciouness and death (Engels 1978:224).

    13 subfebrile temperatures muscular rigidity, photophobia, hypersensitivity

    to noise, and lassitude (Engels 1978:224).

    14 Mdicine et mdicins (Paris 1872:406-415); reference in Engels (1978:225 n.8).

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    recently been re-examined by Engels (1978:224-228). The malarialparasite is known to have existed on earth since antiquity and malariahas been endemic to the eastern Mediterranean at least since the 6th

    century BC (Grmek 1991:280). Alexanders final illness shows symp-toms characteristic of malignant tertian malaria (Plasmodium falciparuminfection): a violent intermittent fever, severe back pain, and progres-sive loss of consciousness leading to death (Woodruff 1974:49). Hispresence in the swampy Euphrates/Tigris delta immediately before theonset of the disease would be corroborative evidence. Malaria is knownto have been common in those areas, particularly so in the summermonths of June and July. Engels (1978:225) points out that Alexandersweakened condition due to recent wounds, exhaustion and possiblyheavy drinking would have precipitated the infection. He probably diedof the well known and deadly cerebral complications offalciparum ma-laria. Disease was indeed very common among Alexanders troops Engels (1978:227) quotes Arrian (Anabasis 5.27.6) in stating that moresoldiers died of illness than in battle. Although Alexanders final ill-ness could conceivably have been caused by other febrile illnesses ofthe time, Sallares (1991:271) claims that malaria was the commonestcause of fevers in antiquity, and the symptoms known to us would be

    compatible with this diagnosis.It is indeed possible that this was at least Alexanders second attack

    of malaria (Engels 1978:225). When he entered Tarsus in Cilicia (amost virulent malarial location even in modern times) in September333 BC, he became seriously ill with a febrile condition and symp-toms very similar to those of his final illness, including loss of speechand unconsciousness.15 Recovery from severe cerebral malaria is rare,but he was then younger and probably physically fitter, which couldhave contributed to his survival only to succumb to a re-infection

    almost exactly 10 years later.

    15 Recorded by Plutarch (Alexander19.1-9), Arrian (Anabasis 2.4.7-8) and Curtius

    (Historiae Alexandri 3.5.3-3.6.13).

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